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Information from the Pan American Health Organization
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Canada for PAHO
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New Publication from PAHO:  Health, Social Equity, and
Changing Production Patterns in Latin America and the
Caribbean
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Health has assumed increased importance in contemporary
society with the recognition that equitable access to
health services is an essential human right.  As such,
health is viewed as a condition that strengthens
democracy and enhances the legitimacy of the State.
Moreover, health promotion and disease prevention are
basic elements necessary for improving well-being,
fomenting good relations among social groups, and
permitting economic, political, and cultural exchange
among countries.

This publication describes a joint proposal made by
ECLAC and PAHO to improve health conditions and services
in Latin America and the Caribbean.  The first chapter
sets forth the basic concepts that form the foundation
of the proposal, namely, the relationship between
health, productivity, and competitiveness, and the
importance of economic growth with equity.  The health
conditions in the region and their determining factors
are discussed in the next two chapters.  The fourth
chapter analyzes health systems, including such aspects
as organizational models, various forms of financing,
the structure of health spending, and the market for
health goods and services.  Finally, the fifth chapter
presents a proposal regarding the reforms needed to
adapt the health sector to changing production patterns
while increasing equity.  It also touches upon such
topics as intersectoral action and health system
organization, financing, and investment.

Decision makers and experts in the fields of health and
economics will gain from this book important insights
into the processes of health sector reform currently
under way in several countries of Latin America and the
Caribbean.

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Excerpts from Comments by Dr. Enrique Madrigal, Regional
Advisor on Substance Abuse Prevention and Control, PAHO,
at the World No Tobacco Day Forum, May 29, 1998, Ottawa
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The tobacco epidemic has reached such dimensions
worldwide that at this point, it has become a greater
cause of death and disability than any single disease.

In certain regions, the health consequences of tobacco
are particularly devastating.  Further, increasing
consumption in developing nations has counterbalanced a
gradual declining of consumption in developed countries.
In fact, currently tobacco is responsible for three and
a half million deaths a year in the world, and by 2020,
it is expected that this product will kill more people
than any single disease.

Tobacco consumption is now widely conceived as a
pediatric disease, in view that the onset of smoking
hovers, by and large, around the early years of
adolescence.  Further, most risk factors intervening at
this age are the real markers for the ongoing rates of
smoking and disease for the whole population.

The industry has, and still continues to target these
age groups to ensure the profitability of their business
over time.

Curiously, some surveys in the United States reveal that
most teenagers wish to stop smoking, but they find this
very hard to do and many others express that if given
the choice again, they would never have started to
smoke.

In view of the situation, we have learned to admit that
education and information alone are not going to be
sufficient to protect this target population.  That is
why responsible societies must enact strict measures to
assist teenagers, families, communities and schools to
do their job on smoking prevention.  There are some
successful approaches that must be put in place such as
banning advertising and promotion of tobacco products
directed to minors; raising taxes and price of
cigarettes (to date, the most effective single measure
to reduce teenage smoking); reduce exposure to
environmental tobacco, by enforcing smoke free
environments - this in turn will help develop anti-
tobacco social norms; put in place and strictly enforce
banning of sales of tobacco products to minors;
establish, fund, and support comprehensive school and
community level educational and behavioral programs,
which provide an appropriate "psychological
inoculation" through the enhancement of life and refusal
skills.

Latin America and most developing nations in the world
are very vulnerable to the increasing promotion and
commerce of tobacco, as has been stated, which will
counterbalance stricter regulations to curtail tobacco
consumption in developed countries like the United
States and Canada.

Developed nations should build up support to developing
countries as early as possible through strong advocacy,
editorial lines and appeal to the public opinion in
developed nations.  It is admittedly very difficult
still to figure out ways as to how the governmental
policy and health related organizations could directly
assist developing nations in preventing or reversing
current trends on tobacco promotion.

This may be a good time for developed nations to think
more globally, and focus on tobacco as more of a
transnational problem.  The domino theory may be
applicable to this situation.  To avoid this predicted
negative outcome for developing nations, it may be quite
necessary to appeal to the media to start looking for
reliable sources of information on these matters, and
turn these inputs into strong reports and editorial
lines to underline this problem.

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This document is available, with full formatting and
accents, at http://www.csih.org/paho_ndx.html